Fetal growth and birthweight standards as screening tools: methods for evaluating performance.

Please cite this paper as: Hemming K, Bonellie S, Hutton J. Fetal growth and birthweight standards as screening tools: methods for evaluating performance. BJOG 2011;118:1477-1483. Objective  To discuss different methods for evaluating fetal growth and population-based birthweight standards relevant to different uses: either in antenatal care or in epidemiology. Design  Population-based cohort study. Setting  Routinely collected data in Scotland. Population  A total of 540 849 singletons born after 24 weeks between 1980 and 2003. Methods  The performance of a fetal growth standard and a population-based birthweight standard are compared in two ways. First, we consider the accuracy of estimated risks of stillbirth at any point during the remaining pregnancy, a measure that is relevant in antenatal care. Second, the rates of stillbirth at each gestation, which are measures relevant in epidemiology, are compared with the actual rates. Main outcome measures  Standard measures of screening and diagnostic performance: sensitivity, specificity, and positive and negative predictive values. Results  In clinical care, the evidence points towards using fetal growth standards: sensitivity at term is about 30%, increasing to 43% for preterm births (24-31 weeks of gestation), compared with about 29% across all ages under the birthweight standard. Positive predictive values are about 1% across gestations. For epidemiology, the evidence is not so clear-cut: preterm, the population birthweight standard has higher sensitivity and specificity, but this is not the case in the full-term weeks. Conclusions  The performance of fetal growth and birthweight standards should be evaluated in different ways, depending on whether they are intended for use in antenatal care or in epidemiological investigations.